Background and AimsUnited States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self‐reported URiM from the residency interview process across various specialties.MethodsThis was a retrospective cross‐sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five‐point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non‐URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry).ResultsThe study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non‐URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P < .01, two‐sample t‐test). Non‐URiM applicants were younger, and the percentage of male and AOA applicants was greater among non‐URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi‐Square test; 2.9% vs 1.2%, P < .01, Chi‐Square test, respectively).ConclusionUsing a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed.

Four captured moments of various scenes from 1000 Cut Journey, depicting both what the user is doing in the real world and what the user sees in virtual reality. The scenes depict Michael Sterling, a Black male, at three different time points in his life: (A) at age 7, sitting on the floor playing with blocks and being unfairly disciplined by a teacher and taunted by children; (B) at age 15, kneeling on the ground while experiencing an intense interaction with aggressive police; (C) at age 30, being ignored and dismissed during a professional interaction surrounding a job interview; and (D) again at age 30 sharing a big moment with a romantic partner while listening to a voicemail from the interviewer explaining, "You aren't a good cultural fit for the organization." One of the users depicted is a creator of the virtual reality experience; the other is an author of the Innovation Report.